Does Point-of-Care Ultrasound-Guided Nerve Block for Geriatric Hip Fracture Analgesia in the Emergency Department Improve Outcomes?

Background Geriatric hip fractures are a commonly encountered in the emergency department (ED) with significant associated morbidity and mortality. Providing appropriate analgesia has many challenges, and the majority of patients require opioid medications for adequate pain control. Complications of opioids include delirium, respiratory depression, and constipation, among others. Ultrasound-guided nerve blocks for hip fractures have emerged as an additional modality to utilize as part of a multimodal approach to analgesia. Clinical Question In older adults diagnosed with hip fractures in the ED, do ultrasound-guided nerve blocks improve patient-centered outcomes when compared with standard interventions, such as opioid analgesia? Evidence Review Three studies were reviewed: a systematic review and meta-analysis, a randomized controlled trial, and a prospective feasibility study. Conclusion Compared with standard ED management strategies for analgesia after hip fractures in adults, fascia iliaca compartment blocks do not reduce mortality. Single injection fascia iliaca compartment blocks appeared to improve delirium rates, though this effect was not seen on the included randomized controlled trial. Hospital length-of-stay and opioid use were decreased in patients who received nerve blocks for hip fractures. Some ED literature also supports using femoral nerve blocks as the blocks are feasible, effective, and safe.